ORIGINAL PAPERS
Family Medicine & Primary Care Review 2018; 20(1): 7–12
© Copyright by Wydawnictwo Continuo
Comparative analysis of health problems in students from elementary school and middle school in Lublin, 2010–2015
Katarzyna KocKa
1, A–F, BarBara Ślusarska
1, D, G, agnieszka Bartoszek
1, C, Marcin rząca
2, C, urszula zdyBel-Fałdyga
3, B, GrzeGorz nowicKi
1, F, katarzyna naylor
4, E1 department of Family Medicine and community nursing, chair of oncology and environmental Health, Faculty of Health sciences, Medical university of lublin, Poland
2 department of oncology chair of oncology and environmental Health, Faculty of Health sciences, Medical university of lublin, Poland
3 Health care center of school Medicine “terMed” in lublin, Poland
4 department of didactics and Medical simulation, chair of Human anatomy, i Faculty of Medicine, Medical university of lublin, Poland
A – study design, B – data collection, C – statistical analysis, D – data interpretation, E – Manuscript Preparation, F – literature search, G – Funds collection
Background. the results of the european Health interview surveys, performed in 2014, has indicated that every fourth child in Poland has long-term health problems or chronic diseases.
Objectives. diagnosis and comparison of the most common health problems occurring among children attending primary and middle school.
Material and methods. the study has an epidemiological cross-sectional character, and it is concerned with health problems in the lublin primary and middle school population. the source of data was secondary materials derived from the statistical reporting docu- mentation “collective analysis of students’ health status”, covering the years 2010–2015 and conducted by a nurse of the teaching and learning environment under contract with the national Health Fund.
Results. Health problems were diagnosed in 44.3% (n = 846) of primary school students and 50.6% (n = 804) of middle school students.
excessive body weight and endocrine disorders and eye diseases are significantly more common in the middle school students than in primary school children (p < 0.001). in contrast, younger children are more likely to be diagnosed with hearing and speech disorders (p < 0.001) and increased incidence of injuries (p < 0.05).
Conclusions. the frequency of health disorders increases with the age of the students. the predominant health problem among both primary school and middle school students is defects and diseases of the motor organs. the most common chronic diseases diagnosed among school children are allergic diseases. accidents and injuries are the most common health risks to the developmental age popu- lation.
Key words: students, primary schools, middle schools, public health.
Summary
ISSN 1734-3402, eISSN 2449-8580
this is an open access article distributed under the terms of the creative commons attribution-noncommercial-sharealike 4.0 international (cc By-nc-sa 4.0). license (http://creativecommons.org/licenses/by-nc-sa/4.0/).
kocka k, Ślusarska B, Bartoszek a, rząca M, zdybel-Fałdyga u, nowicki g, naylork. comparative analysis of health problems in stu- dents from elementary school and middle school in lublin, 2010–2015. Fam Med Prim Care Rev 2018; 20(1): 7–12, doi: https://doi.
org/10.5114/fmpcr.2018.73697.
https://doi.org/10.5114/fmpcr.2018.73697
Background
Monitoring of the health status of the population in the developmental age enables early detection of disorders of the body function and the programming and implementation of cor- rective actions leading to the minimization of diagnosed health dysfunctions. this is a significant preventive measure because, according to the european Health survey (eHis) of 2014, every fourth child in Poland has long-term health or chronic illnesses [1]. the HBsc report (Health Behavior in school-aged children) confirmed the severity of the occurrence of a number of indi- cators related to morbidity in a group of school children and emphasized a significant increase in the prevalence of somatic symptoms, such as headaches, abdominal pain or back pain [2].
the data available in literature confirms that young people un- dertake risky behaviors, such as addictive substances, low levels of physical activity or irregular consumption of foods, that re- sult in increased health problems. research conducted by the Food and nutrition institute (Fni) clearly indicates the existence
of the problem of excessive weight gain in children and adoles- cents of school age. overweight and obesity diagnosed during childhood increases the risk of metabolic diseases. the health consequences of overweight are rarely observed in young peo- ple, but they relate to 70–80% of the adult population, who gained weight during their adolescence [3]. in addition, chang- ing socio-economic and environmental factors contribute to the increase of civilizational diseases diagnosed in children and adolescents, increasing the risk of carbohydrate-lipid disorders as well as allergic diseases [4]. this is confirmed by szymbor- ski’s analysis of the health status of children and adolescents, where in a population of 0–14 years (n = 5,783), almost 31% of the patients had at least one chronic disease or condition. For comparison, in 2004, chronic diseases were reported in 22.4%
of children. in the youth group (n = 2446.3 thousand) aged 15–
–19, long-term health problems were reported in 20.5% of the population, where in 2004, health problems were found in less than 15% of the youth. among chronic diseases diagnosed both in children and adolescents, the most common ones were aller-
Family Medicine & Primary Care Review 2018; 20(1)
gies (17% and 11%, respectively) [5]. therefore, improving the health of children and adolescents should be a priority for the health policy of the state, based on sound scientific research.
the above postulation is in line with the World Health organi- zation (WHo), which identifies health goals for europe in the Health 2020 program, highlighted the importance of reduction in health inequalities and the campaign of health promotion.
However, detailed diagnosis concerning the existing health situ- ation and major threats is needed to define specific targets in each country, as well as for identification of the target groups to which prevention and intervention will be directed. as in- dicated by the WHo, the health of children is crucial in deter- mining trends in the health of society as a whole, as the body and health behaviors shaped during the developmental age influence adult life [6]. diagnosis of the actual health situation of children and adolescents is a basis for defining health care priorities and undertaking coordinated and planned preventive actions [7]. in the school environment, comprehensive nursing care is provided by a nurse in the teaching and learning environ- ment, whose responsibilities include systematically performing and interpreting screening tests, which allows for early diagnosis of health disorders. the presented analysis of health problems among primary school and middle school students will enable medical staff to undertake targeted preventive and promotional activities in the school environment.
in literature, there is no national data reporting the results of the screening test concerning pupils enrolled in preventive health care in the educational environment. Few studies pres- ent the results of analyses covering chosen macro-regions of Poland [7–10].
analysis of the literature on the subject showed no informa- tion on the health situation of children and adolescents in the lubelskie voivodship, thus an attempt was made to identify the health problems of the school population in the city of lublin.
Objectives
determining the health status of primary and middle school students by identifying and comparing the most common health problems based on the results of completed preventive examinations, including screening tests, conducted in the teach- ing and learning environment in the lublin region.
Material and methods
the research is an epidemiological cross-sectional study, and it is concerned with health problems in the primary and secondary school population in lublin. the results of screening tests were analyzed for early detection of physical developmen- tal abnormalities, limb movement disorders, visual and auditory defects and information about acquired medical conditions and diseases and other events affecting the health of the student.
the project was to analyze the student data of a selected school located in the lublin region under the care of the non-public Health care center of school Medicine “terMed” in lublin. the source of data was secondary materials derived from the statis- tical reporting documentation “collective analysis of students’
health status”, covering the years 2010–2015 and conducted by a nurse of the teaching and learning environment under con- tract with the national Health Fund. the study used the method of retrospective analysis of documents. in total, the documen- tation analysis involved 4,169 primary school pupils and 1,589 middle school pupils in lublin.
the study was conducted with the consent of the non-pub- lic Health care centre of school Medicine “terMed” in lublin, which, under contract with the national Health Fund, performs preventive health care for pupils.
the results obtained were analyzed statistically. the values of the non-measurable parameters were presented by means of counting and percentage.
For unrelated qualities, the χ2 homogeneity test was used to detect the differences between the groups compared. a signifi- cance level of p < 0.05 was established to indicate the existence of statistically significant differences. data base and statistical studies were performed using statistica 12.0 computer soft- ware (statsoft, Poland).
research was carried out in accordance to ethical principles of scientific research, the declaration of Helsinki, as well as the ethical code of the Polish academy of science. school adminis- trations were informed of the research goals, and their permis- sion was obtained prior to starting the study.
Results
Health problems were diagnosed in 44.3% (n = 1846) of primary school students and 50.6% (n = 804) of middle school students. the occurrence of health problems among students in particular years is presented in table 1.
Table 1. Prevalence of health problems in the group of primary and middle school students in the years 2010–2015
Evaluation indicators School Primary school Middle school General Statistics
School year
2010/11 2011/12 2012/13 2013/14 2014/15 2010/11 2011/12 2012/13 2013/14 2014/15 Primary school Middle school
χ2 p
student health problems n 350 429 397 325 345 213 143 183 152 113 1846 804 18.4 < 0.001
% 43 50 48 39 41 60 44 55 49 43 44.3 50.6
somatic develop-
mental defects low body mass and height
n 60 46 42 31 27 24 24 16 11 11 206 86 0.53 0.466
% 7 5 5 4 3 7 7 5 4 4 4.9 5.4
overweight n 41 33 39 28 37 19 16 15 18 21 178 89 4.61 0.031
% 5 4 5 3 4 5 5 5 6 8 4.3 5.6
obesity n 45 35 42 31 30 26 26 17 31 31 183 131 33.1 < 0.001
% 6 4 5 4 4 7 8 5 10 12 4.4 8.2
general n 146 114 124 90 94 69 66 48 60 63 568 306 28.3 < 0.001
% 18 13 15 11 11 19 20 14 19 24 13.6 19.3
accidents and
injuries general n 40 43 45 40 32 14 22 12 12 8 200 68 0.69 0.044
% 5 5 5 5 4 4 7 4 4 3 4.8 4.3
on the school grounds
n 20 22 20 23 16 4 4 4 5 7 101 24 4.51 0.033
% 2 3 2 3 2 1 1 1 2 3 2.4 1.5
Family Medicine & Primary Care Review 2018; 20(1) Table 2. Prevalence of chronic diseases among primary and middle school students in the years 2010–2015
Evaluation indi-
cators School Primary school Middle school General Statistics
School year
2010/11 2011/12 2012/13 2013/14 2014/15 2010/11 2011/12 2012/13 2013/14 2014/15 Primary school Middle school
χ2 p
eye conditions, problems and
diseases n 128 139 126 120 126 78 75 68 66 66 639 353 33.1 < 0.001
% 16 16 16 15 15 22 23 20 21 25 15.3 22.2
chronic diseases of the hearing and speech organs
hearing impedi- ments
n 1 3 2 1 4 0 0 0 0 0 11 0 4.20 0.040
% 0 0 0 0 0 0 0 0 0 0 0.3 0
speech impedi- ments
n 30 27 20 26 27 2 2 3 0 2 130 9 31.8 0.004
% 4 3 2 3 3 1 1 1 0 1 3.1 0.6
general n 31 30 22 27 31 2 2 3 0 2 141 9 35.95 < 0.001
% 4 4 3 3 4 1 1 1 0 1 3.4 0.6
Motor defects
and diseases scoliosis n 12 8 5 17 16 19 17 18 12 9 58 75 56.50 < 0.001
% 1 1 1 2 2 5 5 5 4 3 1.4 4.7
excessive thoracic kyphosis
n 0 2 3 1 0 0 0 2 2 0 6 4 0.77 0.378
% 0 0 0 0 0 0 0 1 1 0 0.1 0.3
deformi- ties of the knees, feet
n 113 120 129 103 140 5 9 15 13 27 605 69 115.12 < 0.001
% 14 14 16 12 16 1 3 5 4 10 14.5 4.3
general n 242 210 235 201 226 87 94 97 66 83 1114 427 0.01 0.909
% 30 25 29 24 27 25 29 29 21 31 26.7 26.9
respiratory sys-
tem diseases allergies n 19 26 27 20 38 14 6 11 12 8 130 51 0.03 0.585
% 2 3 3 2 4 4 2 3 4 3 3.1 3.2
asthma n 18 32 28 23 20 13 12 8 6 11 121 50 0.23 0.626
% 2 4 3 3 2 4 4 2 2 4 2.9 3.1
general n 37 59 56 43 58 27 18 19 18 19 253 101 0.16 0.685
% 5 7 7 5 7 8 6 6 6 7 6.1 6.4
diseases and disorders of the
cardiovascular system – total n 7 2 4 8 11 5 3 2 4 3 32 17 1.25 0.264
% 1 0 0 1 1 1 1 1 1 1 0.8 1.10
chronic urinary tract diseases n 1 1 4 4 4 2 2 0 0 1 14 5 0.01 0.899
% 0 0 0 0 0 1 1 0 0 0 0.3 0.3
Permanent cns damage
– overall n 3 4 2 2 2 2 0 1 3 3 13 9 1.96 0.161
% 0 0 0 0 0 1 0 0 1 1 0.3 0.6
other diseases
requiring care diabetes n 6 2 0 2 0 1 3 5 5 3 10 17 16.98 < 0.001
% 1 0 0 0 0 0 1 2 2 1 0.2 1.1
thyroid
diseases n 2 2 5 5 3 4 1 1 5 5 17 16 7.24 < 0.001
% 0 0 1 1 0 1 0 0 2 2 0.4 1
cancer n 1 0 0 1 0 0 0 0 0 0 2 0 0.73 0.382
% 0 0 0 0 0 0 0 0 0 0 0 0
general n 9 5 5 8 6 5 6 6 10 8 33 35 19.63 < 0.001
% 1 1 1 1 1 1 2 2 3 3 0.8 2.2
number of students covered
by specialist medical care n 197 274 237 169 231 127 90 88 93 96 1108 494 11.6 < 0.001
% 24 32 29 20 27 36 28 26 30 36 26.6 31.1
of primary school children and 5.6% (n = 89) of secondary school students were reported as overweight. in contrast, obesity related to 4.4% (n = 183) of primary school children and 8.2% (n = 131) of middle school students. the most common health hazards re- dysfunctions in somatic development among the study group
were found in 13.6% (n = 568) of primary school children and 19.3% (n = 306) of middle school students. among the somatic disorders, excessive weight was the prevailing issue. 4.3% (n = 178)
Family Medicine & Primary Care Review 2018; 20(1)
lated to school children and adolescents were accidents and inju- ries. these events were recorded over a period of five years in the group of 4.8% (n = 200) primary school children, and half of those documented accidents and injuries happened at the school site (2.4%; n = 101). in the group of middle school students, accidents and injuries occurred in 4.3% (n = 68) of the students, including 1.5% (n = 24) on school grounds.
the most common health problems in the group of chronic diseases diagnosed in both groups of middle school students and primary school students were defects and diseases of the motor organs (table 2).
among primary school students, the dominant motor disor- ders were knee osteoarthrosis and pes planus, which related to 14.5% (n = 605) of the children. in contrast, the most common posture defect among secondary school children was scoliosis (4.7%; n = 75). sight defects and diseases were diagnosed in less than 1/4 of middle school students – 22.2% (n – 353), and 15.3% (n = 639) of primary school students. chronic hearing and speech impediments were diagnosed in 3.4% (n = 141) of pri- mary school children and 0.6% (n = 9) of middle school students.
respiratory diseases predominated in the group of chronic diseases concerning children and youth and related to 6.1%
(n = 253) of primary school children and 6.4% (n = 101) of middle school students. the most frequently diagnosed diseases in this group were allergies manifested by the symptoms of respiratory disease (e.g. rhinitis) – 3.1% (n = 130) of primary school chil- dren and 3.2% (n = 51) secondary school children, and bronchial asthma, identified in 2.9% (n = 121) of primary school pupils and 3.1% (n = 50) of middle school students.
as far as other chronic diseases taken under consideration in the developmental-age population, diabetes occurred less frequently in primary school students (0.2%; n = 10) than in middle school students (1.1%; n = 17), whereas thyroid diseases occurred in 0.4% (n = 17) of primary school students and 1%
(n = 16) of middle school students.
the results show that health problems such as excessive weight and endocrine disorders and visually impaired diseases are significantly more common in middle school children (p <
0.001). in contrast, younger children are more likely to be di- agnosed with hearing and speech disorders (p < 0.001) and of injuries and accidents (p < 0.05).
Discussion
the conducted analyses of the collective report “collected analysis of students’ health status” gathered in lublin primary school and middle school covering the years 2010–2015 has al- lowed us to identify the most common health problems in the developing population.
the reported results showed that 44.3% of primary school pupils and 50.6% of middle school students had health prob- lems. the studies of Haor et al. [8], conducted among chil- dren aged 6 and 10, confirm the frequent diagnosis of health problems in the school group. Health problems in the group of 6-year-olds concerned 87.1% of the respondents, whereas in 10-year-old children, health problems were already pres- ent in 93% of the respondents. on the other hand, research conducted by Braczkowska et al. [7] among the general school population in 2005–2006 (n = 1,606) showed that 73.7% of the young people had health problems, which may indicate an in- crease in the incidence of health disorders in older ages. the most common health problems associated with shaping the body posture and intensive growth of the body occurring in the group of pupils of primary school and middle school are static disorders of the motor organs. in our study, this was diag- nosed in 26.7% of the children from primary school and 26.9%
of middle school students. similar results were reported in the study conducted in 2009–2011 by noczyńska et al. [9] in Wro- claw (n = 1984), which reported posture defects in 20.2% of the
children. the number of static disorders of the motor organs in the developmental-age population is shown in the study by Mastalerz-Migas et al. [10], conducted in the opolskie voivode- ship, which found these disorders in 12.4% of the studied group.
according to Woynarowska and oblacińska [11], it is estimated that movement disorders affect 10–80% of the population of Polish children. However, there exist extensive discrepancies in the evaluation of the incidence of postural defects, likely due to a lack of standardized diagnostic criteria and postgraduates of ontogenetic courses. a frequent medical disorder in the group of children tested in lublin was eye defects. these were diag- nosed in 22.2% of middle school students and 15.3% of primary school students. in the group of Wroclaw children aged 6.5–9.5 years, visual impairment occurred in 11.8% of the respondents [9]. in contrast, studies of children aged 7–15 from Poznan con- firmed the presence of vision defects in 43% of the respondents [12]. comparing the results of own research with other authors, one can notice that with the increase in age in children, the per- centage of people with visual impairment also increases. this fact is probably due to the high strain to eyesight during school hours, often accompanied by inadequate lighting and an inad- equate environment for an individual’s physical development.
as indicated by literature, hearing impairment is the most common defect associated with verbal communication disorders [13]. czech et al. [14] report that every tenth child of preschool age and every sixth of school age has temporary or permanent hearing loss of mild or moderate severity. our study indicated the prevalence of this disorder in 3.4% of children from primary school and 0.6% of middle school students. a positive tendency is the reduction in the percentage of children with hearing loss in older age groups as a result of activities undertaken, i.e. phys- iotherapy and speech therapy.
the results of the analysis indicate that somatic develop- mental disorders, including overweight and obesity, represent a significant health problem in the population of school chil- dren. the research lead among school children in lublin con- firmed the occurrence of excessive weight gain in the group of students: 8.7% of primary school students and 13.8% of middle school students. a similar situation was described in children aged 6.5–9.5 years in Wroclaw, in which overweight was found in 13.6% of the respondents [15]. likewise, a study conducted among 16-year-olds in oświęcim found overweight and obe- sity in 7.9% of the total number of students [7]. on the other hand, the HBsc national report [2] indicates that overweight and obesity occur in every seventh teenager, with a visible de- crease in the proportion of adolescents with overweight com- pared to 2010. this situation is most likely due to implementing educational and preventive measures to counter obesity among young people.
subsequently, allergic diseases are an increasing health problem among school children. in the presented population, they concern 6.1% of primary school children and 6.4% of mid- dle school students. studies by Braczkowska et al. [7] indicate the occurrence of allergy in 11.7% of young people at the age of 16 years. durska et al. [16], who conducted a study among szczecin middle school students, diagnosed atopy in 23.8% of the students.
a larger group of children with known allergies were found by noczyńska et al. [9], who encounter them in 30.1% of the population aged 6.5–9.5 years in Wroclaw. according to the re- sults of studies conducted in different Polish cities, there are dif- ferences in the incidence of allergic diseases, which are largely due to environmental and family factors [16].
the impact of environmental factors on allergies in school- -aged children has been confirmed by studies conducted by Mi- yashita et al., Japan, where the effects of natural disasters on the incidence of allergic diseases, such as asthma and eczema, have been observed [17].
accidents and injuries are the leading cause of death and disability among children and adolescents aged 0–19 years. in
Family Medicine & Primary Care Review 2018; 20(1) the studied group of lublin pupils, they were recorded over
a five year period in 4.8% of primary school children and 4.3%
of middle school students. długoń et al. [18], analyzing the epidemiology of injuries among children and adolescents (n = 2245) in 2005–2011, found that the largest group of children consulted by medical personnel for trauma were aged 10–14.
the places where the injuries most often occurred were play- grounds, at home and at school. according to the HBsc report in 2014, every third teenager suffered at least one injury requiring medical attention, and 17.7% of adolescents sustained traumas requiring more demanding treatment, including hospitalization [2]. on the other hand, studies conducted among Portuguese school children showed increased traumas in students attend- ing additional afterschool sports activities, such as training [19].
Limitations of the study
the results of our research were concerned with the analy- sis of the health problems of primary school and middle school students in lublin, analyzing reporting documentation conduct- ed by a nurse of the teaching and learning environment. the number of schools being a source for data analysis was limited.
in addition, high school students were not included in the study, and thus the most common health problems for adolescents aged 16–19 have not been characterized. another aspect that should be noted as a limitation of this study is a retrospective analysis of the method based on data from existing documen-
tation in the medical school, which introduced some possible shortcomings in statistical analysis of the results. a significant limitation in the analysis of the results was the lack of access to raw data – individual student health records, which enabled the inclusion of more quantitative and qualitative data on the respondents, which would allow for the distribution of variables to be analyzed and more advanced statistical correlations to be implemented. the obtained qualitative data, aggregated from individual years, limited us to determining the frequency of specific problems in groups of students. Future studies should therefore be extended to include a larger number of primary schools and analyze the most common health problems among high school students, as well as the need for an additional diag- nostic test.
Conclusions
the analysis of health problems in primary and middle school students in lublin in the years 2010–2015 shows that the frequency of health disorders increases with age. the predomi- nant health problems among both primary school students and middle school students are defects and diseases of the motor organs. the most common chronic conditions diagnosed among school children are allergic diseases. accidents and injuries, on the other hand, are the most common health risks for the devel- oping-age population.
source of funding: this work was funded by the authors’ own resources.
conflict of interest: the authors declare no conflict of interests.
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tables: 2 Figures: 0 references: 19 received: 29.04.2017 reviewed: 05.06.2017 accepted: 25.07.2017 address for correspondence:
katarzyna kocka, Md, Phd
zakład Medycyny rodzinnej i Pielęgniarstwa Środowiskowego katedra onkologii i Środowiskowej opieki zdrowotnej Wydział nauk o zdrowiu uM
ul. staszica 4–6 20-081 lublin Polska
tel.: +48 692 977 547 e-mail: katarzyna48@op.pl
